Correlation of MRI-Lesion Targeted Biopsy vs. Systematic Biopsy Gleason Score with Final Pathological Gleason Score after Radical Prostatectomy

Abstract

Background: The impact of MRI-lesion targeted (TB) and systematic biopsy (SB) Gleason score (GS) as a predictor for final pathological GS still remains unclear. Methods: All patients with TB + SB, and subsequent radical prostatectomy (RP) between 01/2014-12/2020 were analyzed. Rank correlation coefficient predicted concordance with pathological GS for patients’ TB and SB GS, as well as for the combined effect of SB + TB. Results: Of 159 eligible patients, 77% were biopsy naïve. For SB taken in addition to TB, a Spearman’s correlation of +0.33 was observed regarding final GS. Rates of concordance, upgrading, and downgrading were 37.1, 37.1 and 25.8%, respectively. For TB, a +0.52 correlation was computed regarding final GS. Rates of concordance, upgrading and downgrading for TB biopsy GS were 45.9, 33.3, and 20.8%, respectively. For the combination of SB + TB, a correlation of +0.59 was observed. Rates of concordance, upgrading and downgrading were 49.7, 15.1 and 35.2%, respectively. The combined effect of SB + TB resulted in a lower upgrading rate, relative to TB and SB (both p < 0.001), but a higher downgrading rate, relative to TB (p < 0.01). Conclusions: GS obtained from TB provided higher concordance and lower upgrading and downgrading rates, relative to SB GS with regard to final pathology. The combined effect of SB + TB led to the highest concordance rate and the lowest upgrading rate.

Machine Learning-Based Prediction of Pathological Upgrade From Combined Transperineal Systematic and MRI-Targeted Prostate Biopsy to Final Pathology: A Multicenter Retrospective Study

“…Pre-biopsy MRI scan and MRI-guided TB have been widely recommended for men with naïve biopsy or repeat biopsy, as several studies have been proven the improvement of detective rates of PCa or clinically significant PCa ( 8 , 20 , 32 ). Moreover, after RP, pathological upgrade is less likely to occur with MRI-guided TB as previously described ( 33 , 34 ). Our results showed a significantly lower upgrade rate in the combined biopsy, versus SB or TB alone (both p < 0.0001).…”

Adverse upgrading and/or upstaging in contemporary low-risk prostate cancer patients

“…However, these guidelines are based on findings of historical studies [5][6][7][8] when conservative management rates (active surveillance/active monitoring/watchful waiting) were substantially lower than currently 9,10 . Moreover, grading of PCa might have not been the same, since in contemporary patients the combination of systemic and target biopsy has shown to significantly reduce upgrading rates [11][12][13][14] . Similarly, contemporary use of MRI prior to prostate biopsy decreased the rate of clinically insignificant PCa diagnoses at initial biopsy [15][16][17] .…”

Non‐organ confined stage and upgrading rates in exclusive PSA high‐risk prostate cancer patients

“…However, it is of note that population‐based approaches, such as the current design, represent the most promising approach for addressing these hypotheses due to available data magnitude. Second, potential important differences in baseline characteristics which were not assessable within SEER, may have confounded our findings, such as imaging findings (e.g., magnetic resonance imaging), prostate‐associated features (prostate volume, chronic inflammation), and potential bias arising from methodological differences in the process of specimen procurement, fixation and histopathological analyses 17–21 . Moreover, lack of central pathology review may impose a bias that could not be accounted for in the current manuscript.…”

“…Second, potential important differences in baseline characteristics which were not assessable within SEER, may have confounded our findings, such as imaging findings (e.g., magnetic resonance imaging), prostate-associated features (prostate volume, chronic inflammation), and potential bias arising from methodological differences in the process of specimen procurement, fixation and histopathological analyses. [17][18][19][20][21] Moreover, lack of central pathology review may impose a bias that could not be accounted for in the current manuscript. It is of note that this limitation is inherent to all population-based analyses.…”